Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis

Hiral Anil Shah, Anne Meiwald, Chamath Perera, Giacomo Casabona, Peter Richmond, Nicolas Jamet

Research output: Contribution to journalReview articlepeer-review


IntroductionVaricella (chickenpox) is an infectious disease caused by the varicella zoster virus affecting children, adolescents, and adults. Varicella symptoms are usually self-limiting; however, different complications with widespread and systemic manifestations can occur. This systematic literature review aims to explore and quantify varicella-associated complication rates.MethodsTwo databases (Embase and MEDLINE), congress abstracts, and reference lists of systematic reviews were screened to identify evidence on varicella complications. Complications were identified and grouped into 14 clinically relevant categories. Proportional meta-analyses were conducted using a random-effects model and tests for heterogeneity and publication bias were performed. Subgroup, sensitivity, and meta-regression analyses were also conducted. A total of 78 studies, spanning 30 countries, were included in the meta-analysis.ResultsPooled prevalence was highest in severe varicella (22.42%; 95% confidence interval [CI] 10.13-37.77), skin-related complications (20.12%; 95% CI 15.48-25.20), and infection-related complications (10.03%; 95% CI 7.47-12.90). Cardiovascular (0.55%; 95% CI 0.08-1.33), genitourinary (1.17%; 95% CI 0.55-1.99), and musculoskeletal (1.54%; 95% CI 1.06-2.11) complications had the lowest pooled prevalence. The remaining complication categories ranged between 1% and 10%. Subgroup analysis showed that complications were more prevalent in children versus adults and in hospitalized patients versus outpatients. Meta-regression analysis found that no ecological level covariates were accurate predictors for the overall prevalence of varicella-associated complications. There was substantial heterogeneity and publication bias across all meta-analyses.ConclusionResults suggest that different types of varicella-associated complications could be frequent, impacting quality of life, and healthcare resource utilisation and budgets. These findings are crucial to raise awareness of the health and economic burden of varicella disease.A graphical plain language summary is available with this article.
Original languageEnglish
Pages (from-to)79-103
Number of pages25
JournalInfectious diseases and therapy
Issue number1
Early online date19 Dec 2023
Publication statusPublished - Jan 2024


Dive into the research topics of 'Global Prevalence of Varicella-Associated Complications: A Systematic Review and Meta-Analysis'. Together they form a unique fingerprint.

Cite this